Articulated plastic biliary stents for complex hilar and bilioenteric strictures

Background: Articulated plastic biliary stents (APBS) allow drainage of multiple biliary segments through a single percutaneous tract and may reduce complications associated with multiple external drains.This study evaluated the technical success, clinical success, safety, and procedural burden of APBS placement in patients with complex hilar and bilioenteric strictures.Methods: A retrospective single-center review was performed of all patients who underwent APBS placement between July 2014 and March 2025.Patient demographics, obstruction etiology, APBS configuration, interval from initial percutaneous transhepatic biliary drainage (PTBD) to APBS placement, number of repeat procedures, indications for repeat procedures, laboratory response, and follow-up outcomes were analyzed.Technical success was defined as fluoroscopically confirmed articulation of the stent and drain with successful biliary drainage.Clinical success was defined as improvement in presenting symptoms plus either a greater than 20% decrease in total bilirubin within 7 days in patients with elevated baseline bilirubin or improvement in cholestatic liver tests within 2 weeks in patients without marked baseline hyperbilirubinemia.Results: Fifteen patients underwent APBS placement during the study period.Technical success was achieved in 100% of cases (n = 15), and clinical success was achieved in 86.7% of cases (n = 13).Most patients (73.3%, n = 11) had hepaticojejunostomy strictures, frequently in the post-liver transplant setting.Patients required a mean of 6.1 procedures during their treatment course.Of the 77 follow-up procedures, 63 were planned exchanges and 14 were unplanned reinterventions for stent occlusion, abdominal pain, cholangitis, migration, bile leak, or catheter malfunction.The mean interval between initial PTBD placement and APBS placement was 304 days.Median follow-up was 8 months.No major immediate complications occurred; delayed adverse events included recurrent cholangitis.Conclusion: APBS placement is a technically feasible and clinically effective percutaneous option for managing complex hilar and bilioenteric strictures, particularly in patients who are not candidates for endoscopic management.This approach facilitates multisegment biliary drainage through a single access tract while reducing external catheter burden.